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General NPI Number Information
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NPI Number | 1720405939
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Entity Type | Individual
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Provider Name | HEIDI NICOLE RIVIELLO PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 171 LAKE ST
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City | RAMSEY
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State | NJ
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Zip | 07446-2089
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Country | US
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Telephone | 17-850-0112
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Fax | 201-785-9100
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Provider Business Mailing Address
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Address Line | 1033 US HIGHWAY 46 STE 102
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City | CLIFTON
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State | NJ
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Zip | 07013-2448
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Country | US
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Telephone | 973-799-7979
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Fax | 973-799-7970
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3159
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MP00599500
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License Number State | NJ
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